Panic disorder, cardiac diagnosis and emergency department utilization in an epidemiologic community sample

ObjectiveWe examined the association between panic disorder (PD), physician-diagnosed cardiac disease (CD), and the interaction of these variables in relation to health care utilization, as measured by emergency department (ED) visitations, in an epidemiologic sample.MethodsSubjects were identified from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of 43,093 adult respondents from the United States who completed face-to-face computer-assisted structured clinical interviews.ResultsAmong patients with CD, the 12-month prevalence of PD (6.0%; 613/10,239) was significantly higher than that among non-CD subjects (3.4%; 1106/32,854; adjusted odds ratio=2.4; 95% confidence interval=2.2–2.7). CD patients with PD had a significantly greater prevalence of angina, tachycardia and alcohol use disorders as compared with PD-negative patients. PD-positive patients reported significantly greater mean 12-month ED visits (1.2) as compared with the PD-negative patients (0.6; P<.001). PD and tachycardia were found to have a significant interaction effect on ED visits for males (F=25.1; df=1,7; P<.001) but not for females (F=1.2; df=1,7; P=.28), with age, income, race and alcohol use included as covariates.ConclusionsEpidemiological data support a relationship between PD and CD that impacts ED utilization. These findings have potential implications for medical, psychiatric and ED-based screening and interventions.